PMID- 29057539
OWN - NLM
STAT- MEDLINE
DCOM- 20190401
LR  - 20220410
IS  - 1365-2125 (Electronic)
IS  - 0306-5251 (Print)
IS  - 0306-5251 (Linking)
VI  - 84
IP  - 2
DP  - 2018 Feb
TI  - Comparative safety of systemic and low-bioavailability steroids in inflammatory 
      bowel disease: Systematic review and network meta-analysis.
PG  - 239-251
LID - 10.1111/bcp.13456 [doi]
AB  - AIMS: Oral systemic corticosteroids have been used to induce remission in 
      patients with active inflammatory bowel disease (IBD) for over 50 years; however, 
      the wide array of adverse events (AEs) associated with these drugs prompted the 
      development of steroid compounds with targeted delivery and low systemic 
      bioavailability. This study assessed corticosteroids' comparative harm using 
      network meta-analysis. METHODS: We searched PubMed, Scopus, Embase, the Cochrane 
      Library, clinical trial registries, regulatory authorities' websites and major 
      conference proceedings, through March 2017. Randomized controlled trials that 
      recruited adult IBD patients and compared oral systemic corticosteroids 
      (prednisone/prednisolone) or compounds/formulations with low systemic 
      bioavailability (budesonide, budesonide MMX, and beclomethasone dipropionate) 
      with placebo, or against each other, were considered eligible for inclusion. Two 
      reviewers independently extracted study data and outcomes, and rated each trial's 
      risk-of-bias. RESULTS: We identified and synthesized evidence from 31 trials 
      including 5689 IBD patients. Budesonide MMX was associated with significantly 
      fewer corticosteroid-related AEs than oral systemic corticosteroids [odds ratio 
      (OR): 0.25, 95% confidence interval (CI): 0.13-0.49] and beclomethasone (OR: 
      0.35, 95% CI: 0.13-1.00), but not significantly fewer AEs than budesonide (OR: 
      0.64, 95% CI: 0.37-1.11); it performed equally good with placebo. By contrast, 
      the occurrence of serious AEs, and treatment discontinuations due to AEs, did not 
      differ between the comparator treatments. CONCLUSIONS: Budesonide MMX is 
      associated with fewer corticosteroid-related AEs than its comparator steroid 
      treatments for adult IBD patients. Further high-quality research is warranted to 
      illuminate the steroid drugs' comparative safety profiles.
CI  - (c) 2017 The British Pharmacological Society.
FAU - Bonovas, Stefanos
AU  - Bonovas S
AUID- ORCID: 0000-0001-6102-6579
AD  - Department of Biomedical Sciences, Humanitas University, Milan, Italy.
AD  - IBD Center, Department of Gastroenterology, Humanitas Clinical and Research 
      Center, Milan, Italy.
FAU - Nikolopoulos, Georgios K
AU  - Nikolopoulos GK
AD  - Medical School, University of Cyprus, Nicosia, Cyprus.
FAU - Lytras, Theodore
AU  - Lytras T
AD  - Hellenic Center for Disease Control and Prevention, Athens, Greece.
AD  - Department of Experimental and Health Sciences, Pompeu Fabra University, 
      Barcelona, Spain.
AD  - Barcelona Institute for Global Health, Barcelona, Spain.
FAU - Fiorino, Gionata
AU  - Fiorino G
AD  - IBD Center, Department of Gastroenterology, Humanitas Clinical and Research 
      Center, Milan, Italy.
FAU - Peyrin-Biroulet, Laurent
AU  - Peyrin-Biroulet L
AD  - Department of Hepato-Gastroenterology and Inserm U954, University Hospital of 
      Nancy, University of Lorraine, Vandoeuvre-les-Nancy, France.
FAU - Danese, Silvio
AU  - Danese S
AD  - Department of Biomedical Sciences, Humanitas University, Milan, Italy.
AD  - IBD Center, Department of Gastroenterology, Humanitas Clinical and Research 
      Center, Milan, Italy.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20171201
PL  - England
TA  - Br J Clin Pharmacol
JT  - British journal of clinical pharmacology
JID - 7503323
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Glucocorticoids)
SB  - IM
MH  - Anti-Inflammatory Agents/administration & dosage/*adverse 
      effects/pharmacokinetics/therapeutic use
MH  - Biological Availability
MH  - Drug Delivery Systems
MH  - Drug-Related Side Effects and Adverse Reactions/epidemiology/*etiology
MH  - Early Termination of Clinical Trials
MH  - Female
MH  - Glucocorticoids/administration & dosage/*adverse 
      effects/pharmacokinetics/therapeutic use
MH  - Humans
MH  - Inflammatory Bowel Diseases/*drug therapy
MH  - Male
MH  - Randomized Controlled Trials as Topic
PMC - PMC5777428
OTO - NOTNLM
OT  - Crohn's disease
OT  - glucocorticosteroids
OT  - inflammatory bowel disease
OT  - network meta-analysis
OT  - systematic review
OT  - ulcerative colitis
EDAT- 2017/10/24 06:00
MHDA- 2019/04/02 06:00
PMCR- 2019/02/01
CRDT- 2017/10/24 06:00
PHST- 2017/05/06 00:00 [received]
PHST- 2017/09/17 00:00 [revised]
PHST- 2017/10/13 00:00 [accepted]
PHST- 2017/10/24 06:00 [pubmed]
PHST- 2019/04/02 06:00 [medline]
PHST- 2017/10/24 06:00 [entrez]
PHST- 2019/02/01 00:00 [pmc-release]
AID - BCP13456 [pii]
AID - 10.1111/bcp.13456 [doi]
PST - ppublish
SO  - Br J Clin Pharmacol. 2018 Feb;84(2):239-251. doi: 10.1111/bcp.13456. Epub 2017 
      Dec 1.